Friday, October 12, 2018

Rotation 4: Kiddos

Posted by Unknown at Friday, October 12, 2018

My fourth rotation and my second out-of-area rotation was on a general pediatrics unit in an inpatient practice.  I originally elected to do a pediatric rotation because I had zero interest in pediatrics (and I still have zero interest; this isn’t going to be a sappy blog about a transformative, life-changing revelation, so don’t worry).  However, I always try to stand by the policy that you don’t know what you don’t know, so I wanted to make sure that I wasn’t intentionally overlooking an experience just because I suspected that I wouldn’t be interested in it. 

This being my first clinical rotation, I was definitely nervous.  In a way, I knew that I should feel prepared to do patient work-ups, presentations, and care plans because we had done so much of that in school.  On the other hand, regardless of the amount of class time spent practicing a skill, going into a hospital and doing it FOR REAL is a whole different thing.  Fortunately, my preceptor was patient and encouraging, and always made a point to give me feedback so I could continuously improve my patient work-up efficiency and presentation skills.  I had the added benefit of working closely with a PGY2 resident who is a UM COP alumnus..  This was a major advantage for me because even though the resident did not have the years of experience that my preceptor had, we were able to relate more about life, school, and career topics because we are closer together in age and stage of life.  Additionally, everyone else at this site was always SO nice and willing to answer my questions.  It was like having a ton of mini preceptors who all wanted to help me succeed :) 

The pediatric population is generally under-emphasized in class, so I had to change my whole way of approaching patient care.  Everything from normal lab values, to weight-based dosing, to worrying about decimals, to treatment options was different than in the adult setting, so it was almost like re-learning everything I thought I knew.  The learning opportunities were endless, as there are so many pediatric-specific disease states that I had to teach myself every day.

Overall, it was a tremendous learning experience.  Regardless of the fact that I didn't have a specific interest in becoming a pediatric pharmacist going in, I wasn't going to let myself miss out on the value of working in a unique, specialized field with many talented and knowledgeable cohorts.  I had to make a conscious decision to go into each day with an enthusiasm for learning and the confidence to contribute to real decisions regarding patient care.  I can definitely say that I have a new appreciation for this field of work!  For me, my pediatrics rotation was humbling.  Every day I was reminded that no learning opportunity should be disregarded or taken for granted, regardless of my personal interest in it.

Thursday, October 11, 2018

Rotation 1, 2, 3: The Pharmacy Life Chose Me

Posted by Michael Tsai at Thursday, October 11, 2018

Hi Mom! Look, I’m on a blog!

Hello everyone! I hope you have been enjoying the posts by my fellow classmates. Since we aren’t spending our days together in the classroom anymore, it’s been interesting to read about their experiences in all the different settings of pharmacy. 

As fall arrives here in Michigan, here's a look back at my summer experiences:

Community Pharmacy
I had the pleasure of completing my first rotation at an independent specialty pharmacy. The store pharmacy, where I mainly worked, had an organized workflow and offered services, such as immunizations, medication synchronization, and medication therapy management, which set it apart from other pharmacies. My routine started with clarifying prescriptions with doctors if there were any discrepancies in the mornings. Throughout the day, in addition to helping with the dispensing process, I answered several questions from patients. Patient questions included anything about over-the-counter products, side effects, drug interactions, and device administration. Being able to fully assess patient characteristics and quickly refer to drug information references were essential on this rotation. I also conducted phone calls for medication therapy management and adherence checks to ensure that patients had an optimal therapy regimen in place and that they did not have issues getting their refills. 

On this rotation, I also had the opportunity to tour the corporate headquarters and shadow the process of a prescription order and follow-up for patients around the country. Much work goes into making sure the patient receives their medication on time and in optimal condition. Something as detailed as weather conditions need to be monitored as these changes may affect the stability and efficacy of medications. Patients are also kept in close contact to ensure that the medication is working for them and that any side effects they are experiencing are properly managed. Since specialty pharmacy is a hot topic these days, it was very insightful to see how one operates on a national scale, especially considering its interactions with different stakeholders, including healthcare providers, the pharmaceutical industry, and healthcare payors.

As a community pharmacy rotation, this rotation helped further develop my patient counseling skills and showed me all the behind-the-counter work that goes into dispensing a prescription and running a store. I am grateful I got to see the corporate side and the various roles pharmacist play in that setting as well.

Non-traditional Pharmacy
My second rotation was at the Food and Drug Administration (FDA) in Maryland. Though hesitant at first, I ended up enjoying the adventurous drive to Maryland and even stopped along the way at the United 93 Memorial in Pennsylvania, which was very sobering and momentous. 

I had an incredible time learning about drug development and drug regulation. I was placed in the Office of Clinical Pharmacology, which focuses on studying pharmacodynamics (what the drug does to the body) and pharmacokinetics (what the body does to the drug) with a given dose and dosage form. Clinical pharmacology reviewers determine if the proposed dose is safe and efficacious with statistical analysis that the pharmaceutical company provides. Sometimes, reviewers will conduct further analysis to confirm the findings. While this office consists mainly of Ph.D. graduates instead of Pharm.D. graduates, there still are pharmacists that pursue additional training to become well-versed in clinical pharmacology. 

My project for this rotation focused on developing a training program for new clinical pharmacology reviewers. The program centered around building a knowledge system of past reviews to help reviewers make decisions on current reviews. Through that, I learned much about using publicly available information. It’s surprising how much one can learn from reading past reviews and going through several reviews can give a bigger picture of regulatory standards from a clinical pharmacology standpoint. Besides attending several internal meetings, I also attended lectures about the different roles for pharmacists in government agencies. Along with my previous rotation, this rotation has me questioning my post-graduate career plans (which I hear is common among P4 students).

Being in another state was also an amazing experience. I spent my free time exploring the area and befriended many locals and pharmacy students.

Ambulatory Care Pharmacy
When I first began exploring pharmacy as a career path, I thought ambulatory care pharmacy meant a pharmacist working in or with ambulances. I quickly learned I was wrong. The best way I would describe the field of ambulatory care is helping patients manage illnesses through individualized clinic or phone visits. On this rotation, I primarily focused on diabetes management. Patients who were still having trouble with their glucose levels while being cared for by their primary care doctor could be referred to the pharmacist. One of the physicians personally told me that she was grateful to have a pharmacist who could focus one visit on solely addressing diabetes, since many times physicians did not have time during their visits. Patients would always want to bring up other concerns.

On this rotation, I was responsible for collecting information from patients, including their dietary and exercise habits, their blood glucose readings, and their medications. I would then discuss this information with my preceptor and come up with a plan on how to best help the patient moving forward and relay this to the patient. This plan is very individualized and could be either specific changes to improve diet and exercise or adjusting medication regimens. Additionally, it was very important for the patient to agree to this plan. Only then would the patient have the motivation to carry it out. In addition to lifestyle and medications, I also gained exposure to the medical device world. As many patients with diabetes were on insulin therapy, they needed glucometers, test strips, and lancets to optimize insulin dosing. I also learned about continuous glucose monitors, which are implanted into a patient’s arm and save patients from having to poke themselves several times a day. 

All in all, I truly enjoyed engaging with patients and setting goals with them. It was inspiring to see some of them become more involved in taking care of their own health, which resulted in positive outcomes after subsequent visits. 

Friday, October 5, 2018

Rotation 4: Drug Information

Posted by Unknown at Friday, October 05, 2018

During the last 5 weeks, I had the opportunity to work with a well known drug information company and had a great experience!

Before the rotation started, I talked to multiple people who had this rotation in the past and came in with some specific expectations. While my expectations pretty much held up (time requirement, workload, preceptor style), I learned it is important to continue keeping an open mind going into any rotation no matter what you were told by others.

First, I'll let you know that this is one of the only rotations where you get to work from home!! It was amazing and I really enjoyed setting my own schedule and working at my pace! That being said, you have to manage your time well and hold yourself accountable to getting all the work done. I met with my preceptor (and fellow classmate on rotation with me) three times a week. These meetings were between 20 minutes and 1 hour and were helpful in keeping me on track with the rotation work. My preceptor was a great resource and was very receptive to questions and suggestions. She also gave great feedback and really helped refine my skills.

My preceptor worked in the drug interaction section of the company, so we worked on updating and creating drug interaction monographs. After this rotation, I feel a lot more comfortable doing PubMed searches because of all the searching I did for this rotation! I know I will take the skills I learned in this rotation and bring them with me wherever I go! I also learned how to write concise, one sentence summaries of clinical studies for the monographs. This is a very specific kind of writing and I think it will be helpful in the future when I am writing papers and in residency. I also got to explore topics I didn't know much about during three longitudinal projects (drugs that prolong QTc, possible UGT1A1 inducers/inhibitors and interactions with smoking).

I feel really proud of the work I did this rotation. There are people all over the world who will use the monographs I created to help patients! I can go and lookup the drug interaction (e.g., omeprazole and ginkgo biloba) and see one of the monographs I created! I feel so excited thinking that I contributed something so practical and widely used to the field of pharmacy and medicine!

Two things to remember:
-Keep an open mind going into any experience and put your best foot forward!
-Make sure you take time and enjoy this beautiful life, no matter how busy it gets!

Exploring Maine: Acadia National Park (top) and Baxter State Park (bottom)